HBV and HCV genome in peripheral blood mononuclear cells in patients undergoing chronic hemodialysis

HBV and HCV genome in peripheral blood mononuclear cells in patients undergoing chronic hemodialysis. Patients undergoing chronic hemodialysis are at risk for infection with hepatitis B virus (HBV) and hepatitis C virus (HCV). As peripheral blood mononuclear cells (PMNC) are known to be susceptible to infection of both HBV and HCV, assessment of viral genomes in those cells could uncover occult infections not detected by serologic methods or virus determination in serum. We investigated all 67 patients undergoing chronic hemodialysis at a single dialysis unit by PCR for the presence of HBV or HCV genomes in serum as well as in PMNC. None of the 67 patients was HBsAg positive or showed HBV-DNA in serum, but in 5 patients HBV-DNA in PMNC was detected as the only marker of HBV-infection; those patients were also anti-HBc negative. In 9 patients HCV-RNA was positive in serum; in 5 of those patients it was also found in PMNC. Three of these infected patients were negative for anti-HCV. One other patient had no anti-HCV or HCV-RNA in serum, but was positive for HCV-RNA in PMNC. Thus, in 6 patients (8.9%) undergoing chronic hemodialysis we found evidence of infection with HBV or HCV by detecting viral genomes in PMNC without the presence of viremia, antigenemia or specific viral antibodies in serum. The detection of viral genomes in PMNC could be useful in the positive identification of additional potentially infectious patients

Development and evaluation of a cancer-related fatigue patient education program: protocol of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Cancer-related fatigue (CRF) and its impact on patients' quality of life has been an increasing subject of research. However, in Germany there is a lack of evidence-based interventions consistent with the multidimensional character of fatigue. The objective of this study is to develop and evaluate a self-management program for disease-free cancer patients to cope with CRF.</p> <p>Methods</p> <p>Based on evidence extracted from a literature review, a curriculum for the self-management program was elaborated. The curriculum was reviewed and validated by an interdisciplinary expert group and the training-modules will be pretested with a small number of participants and discussed in terms of feasibility and acceptance.</p> <p>To determine the efficacy of the program a randomised controlled trial will be carried out: 300 patients will be recruited from oncological practices in Bremen, Germany, and will be allocated to intervention or control group. The intervention group participates in the program, whereas the control group receives standard care and the opportunity to take part in the program after the end of the follow-up (waiting control group). Primary outcome measure is the level of fatigue, secondary outcome measures are quality of life, depression, anxiety, self-efficacy and physical activity. Data will be collected before randomisation, after intervention, and after a follow-up of 6 months.</p> <p>Discussion</p> <p>Because there are no comparable self-management programs for cancer survivors with fatigue, the development of the curriculum has been complex; therefore, the critical appraisal by the experts was an important step to validate the program and their contributions have been integrated into the curriculum. The experts appreciated the program as filling a gap in outpatient cancer care.</p> <p>If the results of the evaluation prove to be satisfactory, the outpatient care of cancer patients can be broadened and supplemented.</p> <p>Trial Registration</p> <p>ClinicalTrials NCT00552552</p

Trauma- und belastungsbezogene Störungen : neue Herausforderungen in der Klinischen Kinderpsychologie

Mit der Einführung des DSM-5 wurden die Traumafolgestörungen in einem neuen Kapitel „Trauma- und belastungsbezogene Störungen” gruppiert. Außerdem sollte einer Entwicklungsperspektive mehr Rechnung getragen werden, z. B. mit der Einführung spezifischer Kriterien für die posttraumatische Belastungsstörung bei Kindern unter sechs Jahren. Auch in der geplanten elften Auflage der ICD wird es ein derartiges Kapitel geben, wobei hier aller Voraussicht nach neue Diagnosen inkludiert werden, nämlich die komplexe posttraumatische Belastungsstörung und die anhaltende Trauerstörung. Neben der weiteren Adaption dieser Diagnosen auf Kinder und Jugendliche sollten die zukünftigen Forschungsbemühungen verstärkt spezielle Patientengruppen berücksichtigen und die Dissemination der als wirksam evaluierten traumafokussierten Therapieverfahren vorantreiben